Surgical practice patterns in endometrial cancer: results of the Korean Gynecologic Oncology Group survey

Abstract

Objective: This study was undertaken to document current practice patterns for the surgical treatment of endometrial cancer in Korea. Methods: Questionnaires were distributed to 131 Korean gynecologic oncologists, all members of the Korean Gynecologic Oncology Group. Questions addressed extent of hysterectomy procedure, pelvic (PEN) or paraaortic (PAN) lymph node dissection, ovarian preservation, and omentectomy. Results: Completed questionnaires were returned by 64.1% (84/131) of the oncologists at 50 institutes. Extrafascial hysterectomy (EH) was used by 32% of respondents and modified radical hysterectomy (MRH) or radical hysterectomy (RH) by 17%. Hysterectomy procedures were selectively employed based on tumor-related factors by 51% of the respondents. Laparoscopic hysterectomy was routinely utilized by 49% and was more commonly used by younger surgeons with 10 years of experience or less. PEN dissection was routinely utilized by 67% and was used selectively based on tumor-related factors by 33%. PAN dissection/biopsy was used either routinely (43%) or selectively based on tumor-related factors (43%). PAN dissection/biopsy had never been employed by 12% of the respondents. Sixty-nine percent of respondents stated that grossly normal looking ovaries can be preserved during surgery in young aged patients with early stage disease, and 29% stated that bilateral oophorectomy should be performed irrespective of age or stage. Omentectomy was routinely performed by 11% of respondents, and was selectively performed when extrauterine spread was present by 41%. Conclusion: Surgical procedures for the treatment of endometrial cancer are still not standardized among Korean gynecologic surgeons. Clinical trials to determine the benefits of the different surgical procedures should be developed.

Lymphadenectomy can be omitted for low-risk endometrial cancer based on preoperative assessments

“…According to the FIGO staging, some surgeons believe that lymphadenectomy should be performed in all patients to enable the accurate staging and to assess the necessity for postoperative treatment. Indeed, pelvic and para-aortic lymphadenectomy have been performed in many institutions in Asia (approximately 67% to 98% and 43% to 93%, respectively) [ 3 , 4 ]. However, there are some risks to lymphadenectomy such as postoperative deep vein thrombosis or lower limb lymphedema that may impair the patients' quality of life.…”

How low is low enough? Evaluation of various risk-assessment models for lymph node metastasis in endometrial cancer: a Korean multicenter study

“…However, although there is ongoing controversy concerning the benefit of routine lymphadenectomy [6-8], the general consensus is that there is a certain subset of patients in which the omission of routine lymphadenectomy may be justified [9-11]. …”

Current status in the management of uterine corpus cancer in Korea

“…Even though bilateral salpingo-oophorectomy is recommended as a part of surgical staging for the treatment of uterine corpus cancer, the issue of ovarian-saving surgery for early-stage uterine corpus cancer needs further consideration. 59,62 In two case-control Korean studies regarding this issue, it was concluded that ovarian-saving surgery in early-stage disease did not affect disease-free survival and overall survival with a mean of 39 months follow-up 63 and recurrence. 64 They suggested young patients with a low pre-operative CA-125 and low tumor grade are considered as candidates for ovarian-saving surgery.…”